GB2134/B/MCK Sir James MacKenzie
(1853-1925)
Biography
James Mackenzie (1853-1925) was born on April 1853 in
Pickstonhill Farm, Scone, where his father was a tenant farmer and
was the third child and second son. He attended the local school at
Scone and he went to Perth Academy in 1865 but left after three
years to serve an apprenticeship as a dispensing chemist at Reid
& Donald chemists, George Street, Perth, for four years. After
working as an assistant chemist in Glasgow for a year, he decided
to study medicine. After some private tuition in Latin, he passed
the university entrance examination and entered the medical school
at Edinburgh University, qualifying M.B. & C.M. in 1878. He
worked as a locum in a colliery practice at Spennymoor, County
Durham from June of that year till November when his resident post
at Edinburgh Royal infirmary became available. On completing his
residency in 1879, he joined Dr. Briggs and Brown in general
practice in Burnley, an industrial town in England.
He found himself in a very busy practice where the patients
did not correspond to those in the teaching hospital or the
textbooks. In Victorian England, infectious disease was rife, and
in Burnley in 1879 there were 56 deaths from scarlet fever and the
infant mortality was 205/1000 births. He saw 60 to 70 patients
daily and attended an average of three deliveries a week but still
he found time to complete his MD thesis on Hemi-paraplegia Spinalis
in 1882.
In his spare time, he studied Greek and German, played golf
and started to write a novel, which was concerned with the social
deprivation prevalent at that time. In 1885, he was able to afford
the time and the money for a holiday in America. The highlight of
his visit was to Yellowstone Park. Two years later, he married
Frances Jackson and honeymooned in Italy. He had two daughters
Dorothy born in 1888 and Jean in 1893.
While engaged in this very busy practice, he made original
observations and had over fifty papers published. Although many of
his articles were on cardiology, he also wrote on many other topics
particularly neurology and pain mechanisms. He was among the first
to own a motorcar in Burnley and a photograph in one of his
biographies shows him in this car with a driver.
In 1890 he made the seminal observation that the chambers of
the heart could beat out of their correct order, when he discovered
extra systoles. But it was not until the distinguished
pharmacologist, Professor Cushny, demonstrated extra systoles
experimentally in the mammalian heart that Mackenzie's findings
were generally accepted. Before his discoveries were widely known,
many people were made cardiac invalids by the anxiety of their
doctors who, on discovering the irregularity due to extra systoles,
confined the patient needlessly to bed or ordered them to curtail
their activities.
By carefully following up his patients with extra systoles,
Mackenzie showed their benign nature. At first he used a
sphygmograph for graphically recording a peripheral pulse. The
tracings were made on a smoked drum which was then varnished to
preserve the record, a very time consuming process. He then
developed the polygraph, a portable clockwork, ink-writing
instrument with two tambours with which he was able to record
radial and jugular pulses simultaneously and to measure the
atrioventricular interval. He used the polygraph to diagnose the
various types of heart block. This work was all done in the course
of the usual busy medical practice. At this time his knowledge of
cardiology was growing very fast cardiac irregularities were
regarded with concern by the profession and the laity, as none knew
their significance.
In 1897 he noted that in a patient with mitral stenosis, the
presystolic murmur disappeared with the onset of irregularity of
the pulse but he also noted that the 'a' waves in the jugular
venous pulse had also disappeared and concluded that the auricle
was paralyzed, which functionally it was. This disordered
irregularity described by Mackenzie was later called auricular
fibrillation.
Another of his discoveries was the action of digitalis on
conduction in the atrio-ventricular bundle, so slowing the
ventricular response in atrial fibrillation. He also devised a
safer and simpler regimen for prescribing digitalis.
He managed to find the time to do an immense amount of
research together with a heavy workload of family practice, he had
an enormous capacity for work and was driven by an intense desire
to advance his understanding of disease. Mackenzie was expert with
the polygraph and painstaking in storing and interpreting those
records. He filed his notes and tracings for further reference and
as illustrations in his textbooks. At the age of 49, the first of
his books, "The Study of the Pulse" [1902] was published after
twenty-three years in general practice.
By this time he had become the world clinical authority on
heart disease. His publications attracted the attention of many
famous medical personages and including Weckenbach [from 1902] and
Sir Arthur Keith in 1903. Mackenzie sent the hearts of patients
obtained at autopsy to Keith who studied the pathology particularly
the conducting system.
In 1906 he attended the BMA meeting in Toronto and the GP from
Burnley became engaged in a lively debate with Dr. Morrow,
professor of physiology at McGill University and it appears
Mackenzie got the best of the argument. The following year saw the
formation of The Association of Physicians of Great Britain and
Ireland, the membership of which was limited to 200 hospital
physicians and lectures in clinical medicine. Mackenzie, although a
general practitioner, was elected and opened the discussion on the
heart at the first meeting.
He left Burnley for London and set up as a consultant in
November 1907. He was invited to join the staff of the West End
Hospital for nervous disease under Sir James Purves-Stewart and was
appointed to the staff of Mount Vernon Hospital Hampstead. His
second book, "Diseases of the Heart", was published in 1908. The
following year, he rented consulting rooms in Harley Street and in
a very short time, was very busy with private patients. Although he
was he was elected FRCP in 1909 but his main objective, a place on
the consultant staff of the London Hospital eluded him although he
was appointed lecturer in cardiac research, in 1911 to that
hospital and was allowed the use of six beds.
Mackenzie's third textbook, "Symptoms And Their
Interpretation", was published in 1909 and the following year he
was made an LLD of Aberdeen University. More honours followed in
1911 when he delivered the Oliver Sharpey lecture on heart failure
to the Royal College of Physicians and the Schorstein lectures on
auricular fibrillation to the London Hospital. In 1913 he was
appointed physician in charge of the new cardiac department at the
London hospital and was involved in setting up the military cardiac
department at Mount Vernon hospital. In his eleven years in private
consultant medicine, he did not charge excessive fees but still
earned a considerable amount of money.
In 1915, he was elected a Fellow of the Royal Society; a
knighthood followed later that year. The following year he
published "Principles of Diagnosis and Treatment in Heart
Infections". To all intents he had made it in London, become a
consultant to the prestigious London Hospital, and had done well
financially. So, it seems strange that two years later, at the age
of sixty-four, he decided to leave London and move to St. Andrews
to set up an institute for research in general practice.
By October 1919 he had established his research institute in
St. Andrews and managed to involve all the general practitioners in
the town in his project. He also found the time to publish another
work "The Future of Medicine". The various programmes considered at
the institute included the investigation of pain, of glandular
enlargement, disease of children and consumption, a somewhat
daunting task for five GPs. He was very keen to get the general
practitioner involved in keeping good records and in the
epidemiology of the maladies occurring in practice. He was probably
one of the first to think of epidemiology in terms of
non-infectious diseases. In 1920 he was appointed Honorary
Physician to the King and he put forward proposals for a
postgraduate school for training panel doctors.
In 1923 his large output of textbooks was expanded with the
two publications, "Heart Disease in Pregnancy" and "Angina
Pectoris". The achievements of the institute were modest and it did
not last long after his death but he did draw attention to the
importance of family doctors and their need for special training.
It is worth noting that three university chairs of general practice
in Britain are named in his honour.
Mackenzie had suffered from angina pectoris for many years and
died on a visit to London in January 1925. A post mortem
examination was carried out by his former assistant, Sir John
Parkinson who on Mackenzie's prior instructions, had his heart
taken to the anatomy department of St. Andrews University.
Books and Articles about Mackenzie
The Beloved Physician Dr R McNair Wilson
John Murrary 1926
Sir James Mackenzie MD 1853-1925 General Practitioner. Alex Mair
RCGP 1986 (Available from College Shop £5.99)
Sir James Mackenzie - Physician and Medical Researcher - F
B Smith Oxford Dictionary of National Biography 2004
Sir James Mackenzie: The Burnley Years - A E Wales and J
Shafar. Med Hist. 1967
Jul;11(3):297-304.
Sir James Mackenzie: Views on General Practice Education and
Research Robert Moorhead JRSM Vol 92 Jan 1999
Sir James Mackenzie - Hamish J C Davidson
The St Andrews Institute for Clinical Research: An Early
Experiment in collaboration - Jane MacNaughton. Med Hist, 2002, 46
549-568
Lancashire Pioneers - Sir
James Mackenzie MD
Since 1955 there has been an annual James Mackenzie lecture held
at the Royal College of General Practitioners - these are published
in the BJGP the College's journal.